RESUMEN
Hypertension and blood pressure variability (BPV; SD and average real variability) in primary proteinuric glomerulopathies are not well described. Data were from 433 participants in the NEPTUNE (Nephrotic Syndrome Study Network). Hypertensive BP status was defined as previous history of hypertension or BP ≥140/90 mm Hg for adults/≥95th percentile for children at baseline. BPV was measured in participants with ≥3 visits in the first year. Two-hundred ninety-six adults (43 years [interquartile range, 32-57.8 years], 61.5% male) and 147 children (11 years [interquartile range, 5-14 years], 57.8% male) were evaluated. At baseline, 64.8% of adults and 46.9% of children were hypertensive. Histological diagnosis was associated with hypertensive status in adults (P=0.036). In adults, hypertensive status was associated with lower hazard of complete remission (hazard ratio, 0.36; 95% confidence interval, 0.19-0.68) and greater hazard of achieving the composite end point (end-stage renal disease or estimated glomerular filtration rate decline >40%; hazard ratio, 4.1; 95% confidence interval, 1.4-12). Greater systolic and diastolic SD and average real variability were also associated with greater hazard of reaching the composite end point in adults (all P<0.01). In children, greater BPV was an independent predictor of composite end point (determined by systolic SD and average real variability) and complete remission (determined by systolic and diastolic average real variability; all P<0.05). Hypertensive status was common among adults and children enrolled in NEPTUNE. Differences in hypertensive status prevalence, BPV, and treatment were found by age and histological diagnosis. In addition, hypertensive status and greater BPV were associated with poorer clinical outcomes.
Asunto(s)
Atención Ambulatoria , Determinación de la Presión Sanguínea , Hipertensión , Síndrome Nefrótico , Adolescente , Adulto , Atención Ambulatoria/métodos , Atención Ambulatoria/estadística & datos numéricos , Presión Sanguínea/fisiología , Determinación de la Presión Sanguínea/métodos , Determinación de la Presión Sanguínea/estadística & datos numéricos , Niño , Femenino , Tasa de Filtración Glomerular , Humanos , Hipertensión/diagnóstico , Hipertensión/etiología , Hipertensión/fisiopatología , Hipertensión Maligna/diagnóstico , Hipertensión Maligna/epidemiología , Masculino , Persona de Mediana Edad , Síndrome Nefrótico/complicaciones , Síndrome Nefrótico/epidemiología , Síndrome Nefrótico/fisiopatología , Síndrome Nefrótico/orina , Variaciones Dependientes del Observador , Evaluación de Procesos y Resultados en Atención de Salud , Pronóstico , Modelos de Riesgos Proporcionales , Factores de Riesgo , Estados Unidos/epidemiologíaRESUMEN
INTRODUCTION: The chronic kidney disease outcomes and practice patterns study (CKDopps) is an international observational, prospective, cohort study involving patients with chronic kidney disease (CKD) stages 3-5 [estimated glomerular filtration rate (eGFR) < 60 ml/min/1.73 m2, with a major focus upon care during the advanced CKD period (eGFR < 30 ml/min/1.73 m2)]. During a 1-year enrollment period, each one of the 22 selected clinics will enroll up to 60 advanced CKD patients (eGFR < 30 ml/min/1.73 m2 and not dialysis-dependent) and 20 earlier stage CKD patients (eGFR between 30-59 ml/min/1.73 m2). EXCLUSION CRITERIA: age < 18 years old, patients on chronic dialysis or prior kidney transplant. The study timeline include up to one year for enrollment of patients at each clinic starting in the end of 2013, followed by up to 2-3 years of patient follow-up with collection of detailed longitudinal patient-level data, annual clinic practice-level surveys, and patient surveys. Analyses will apply regression models to evaluate the contribution of patient-level and clinic practice-level factors to study outcomes, and utilize instrumental variable-type techniques when appropriate. CONCLUSION: Launching in 2013, CKDopps Brazil will study advanced CKD care in a random selection of nephrology clinics across Brazil to gain understanding of variation in care across the country, and as part of a multinational study to identify optimal treatment practices to slow kidney disease progression and improve outcomes during the transition period to end-stage kidney disease.
Asunto(s)
Pautas de la Práctica en Medicina , Insuficiencia Renal Crónica/terapia , Brasil , Estudios de Cohortes , Humanos , Cooperación Internacional , Estudios Prospectivos , Resultado del TratamientoRESUMEN
Introduction: The chronic kidney disease outcomes and practice patterns study (CKDopps) is an international observational, prospective, cohort study involving patients with chronic kidney disease (CKD) stages 3-5 [estimated glomerular filtration rate (eGFR) < 60 ml/min/1.73 m2, with a major focus upon care during the advanced CKD period (eGFR < 30 ml/min/1.73 m2)]. During a 1-year enrollment period, each one of the 22 selected clinics will enroll up to 60 advanced CKD patients (eGFR < 30 ml/min/1.73 m2 and not dialysis-dependent) and 20 earlier stage CKD patients (eGFR between 30-59 ml/min/1.73 m2). Exclusion criteria: age < 18 years old, patients on chronic dialysis or prior kidney transplant. The study timeline include up to one year for enrollment of patients at each clinic starting in the end of 2013, followed by up to 2-3 years of patient follow-up with collection of detailed longitudinal patient-level data, annual clinic practice-level surveys, and patient surveys. Analyses will apply regression models to evaluate the contribution of patient-level and clinic practice-level factors to study outcomes, and utilize instrumental variable-type techniques when appropriate. Conclusion: Launching in 2013, CKDopps Brazil will study advanced CKD care in a random selection of nephrology clinics across Brazil to gain understanding of variation in care across the country, and as part of a multinational study to identify optimal treatment practices to slow kidney disease progression and improve outcomes during the transition period to end-stage kidney disease. .
Introdução: O Estudo de padrões da prática e desfechos das doenças renais crônicas (CKDopps) é um estudo internacional observacional, prospectivo, com uma coorte composta de pacientes com doenças renais crônicas (DRC) nos estágios 3-5 [taxa de filtração glomerular estimada (eGFR) < 60 ml/min/1,73 m2, com um grande foco sobre o tratamento durante o período de doença renal crônica avançada (eGFR < 30 ml/min/1,73 m2)]. Durante o período de recrutamento de participantes, de 1 ano, cada uma das 22 clínicas selecionadas inscreverá até 60 pacientes com DRC avançada (eGFR < 30 ml/min/1,73 m2 e não dependente de diálise) e 20 pacientes com DRC em estágios anteriores (eGFR entre 30-59 ml/min/1,73 m2). Os critérios de exclusão são: idade < 18 anos; pacientes em diálise crônica ou transplante de rim prévio. O cronograma de estudo inclui até um ano para a inscrição dos pacientes em cada clínica a partir do final de 2013, sendo então acompanhados por 2-3 anos, com coleta de dados longitudinais detalhados dos pacientes, pesquisas anuais dos níveis da prática na clínica e levantamentos de informação dos pacientes. As análises aplicarão modelos de regressão para avaliar a contribuição de fatores relacionados à clínica e aos próprios pacientes para estudar os desfechos, e utilizar técnicas do tipo: variável instrumental, quando apropriado. Conclusão: Lançado em 2013, o CKDopps-Brasil, avaliará o tratamento de DRC avançada em uma seleção aleatória de clínicas de nefrologia em todo o Brasil para entender como o tratamento varia em nosso país, e como parte de um estudo multinacional para identificar as práticas de tratamento ideal para retardar ...
Asunto(s)
Humanos , Pautas de la Práctica en Medicina , Insuficiencia Renal Crónica/terapia , Brasil , Estudios de Cohortes , Cooperación Internacional , Estudios Prospectivos , Resultado del TratamientoRESUMEN
Este estudio transversal, que se llevó a cabo del 3 de mayo al 30 de septiembre de 1993, consistió en la evaluación con otoscopio pediátrico de una muestra aleatoria de 100 escolares de primer grado en un hospital de Buenos Aires, Argentina, seguida de audiometría tonal y barrido tonal en 90 de estos niños, para detectar la frecuencia de trastornos auditivos y evaluar la importancia del tamizaje audiométrico en la población infantil. Los resultados se clasificaron de acuerdo al tipo y grado de hipoacusia: de conducción o de percepción, y leve, moderada o grave. Se detectó hipoacusia en 36 niños (39 por ciento), de los cuales 35 tuvieron una hipoacusia de conducción leve (pérdida de menos de 31 decibelios [dB] o moderada (pérdida de menos de 41 dB). No se encontraron hipoacusias graves. Consideramos que el tamizaje audiométrico de los niños que ingresan en la escuela primaria esta justificado por la alta frecuencia de trastornos auditivos prevenibles y por las repercusiones que estos suelen tener en el habla y en el aprendizaje